Devery Johnson, Senior Business Consultant
This is definitely an age old question! All those new claims coming in, they must get handled quickly and correctly and you don’t want to overburden some staff while others don’t seem to have enough new claims. You’ve tried round robin, alphabetical distribution, claim type (STD, LTD, Residual), and still the problem remains – trying to maintain an even distribution, while ensuring that the claims are effectively and efficiently handled. Yet, possibly, an even distribution is not necessarily the ideal approach.
Having worked in numerous claims companies, both group and individual, as well as working with many clients, I’ve had the distinct opportunity to observe or implement many variations in dealing with this perplexing issue.
The first thing to keep in mind is that this is not a “one size fits all”. Each company has their own unique features when it comes to new claims, thus the individual needs of each company needs to be kept front and center. However, there are some common threads that run through all insurance companies which can be considered and utilized in order to achieve the ultimate goal.
If we consider the strengths of the staff and aligning these to new claims, it can help to ensure the optimum of claims handling. Possibly consider the following:
- Who is very good on the phone? These individuals can potentially resolve the expected short duration claims quickly and efficiently, by speaking with the claimant? These people are usually very good negotiators and further enjoy the opportunity to engage with the claimant directly.
- Do I have areas of expertise/interest within my claims department? In one of my prior lives, I recognized that I had some staff who were excellent at dealing with the financial aspects of claims and others who were medically focused. By distributing the claims based on these interests, not only were the staff more engaged with the claims, they handled them much more quickly than if they had been dealing with claims where they felt frustrated. It also significantly reduced the training time and allowed a mentorship program to be developed.
- Is the claim complex? Not everyone is equipped to deal with these types of claims – but those that relish the challenge of investigating and getting to the bottom of the real issues are a perfect fit for these most perplexing of claims. Distributing these claims to those with the true skill base to handle them effectively and appropriately allows your staff to provide these claims the focused attention they deserve, and get personal fulfillment along the way.
- How long will it take to actually review the claim, and will it be with that particular claim analyst for a period of time? If this is the case, then it is acceptable that these claims analysts do not receive as many new claims as those that will be resolved quickly, as you want your staff to dedicate themselves to perform a thorough, rather than speedy, analysis.
- Has a relationship developed between a particular group client and a group of analysts? The analysts understand the nuances of a complicated group contract, and thus can cut through the maze to the heart of the matter, vs. someone who is unfamiliar. This creates confidence with the client Benefit Administrator, and can help to avoid some of those conflicts that arise when this assurance is lacking.
While possibly not the traditional approach in the distribution of new claims, potentially this will provide another avenue that could be utilized to achieve the primary objective – the efficient and correct handling of claims.